Mechanisms of resistance to macrolides and lincosamides: nature of the resistance elements and their clinical implications

Clin Infect Dis. 2002 Feb 15;34(4):482-92. doi: 10.1086/324626. Epub 2002 Jan 11.


Resistance to macrolides and lincosamides is increasingly reported in clinical isolates of gram-positive bacteria. The multiplicity of mechanisms of resistance, which include ribosomal modification, efflux of the antibiotic, and drug inactivation, results in a variety of phenotypes of resistance. There is controversy concerning the clinical relevance of in vitro macrolide resistance. Recent data, however, have shown that eradication of bacteria correlates with clinical outcome of acute otitis media in children and that macrolide therapy results in delayed eradication of macrolide-resistant pneumococci. These results support the need for in vitro detection of macrolide resistance and correct interpretation of susceptibility tests to guide therapy.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / metabolism
  • Anti-Bacterial Agents / pharmacology*
  • Biological Transport
  • Biotransformation
  • DNA Methylation
  • DNA, Ribosomal / metabolism
  • Drug Resistance, Bacterial / genetics*
  • Drug Resistance, Bacterial / physiology
  • Genetic Variation
  • Humans
  • Lincosamides
  • Macrolides*
  • Mutation
  • Outcome Assessment, Health Care


  • Anti-Bacterial Agents
  • DNA, Ribosomal
  • Lincosamides
  • Macrolides